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Neither gender nor parenthood force doctors to leave surgery training

While having children or being female is often thought to be linked with the decision to leave a general surgery residency, this is not true, according to a 10-year evaluation of UC Davis residents.

“We looked at a lot of factors, and gender and child rearing weren’t associated with leaving the program,” said lead author Erin Brown, who is currently completing her general surgery residency at UC Davis Health System. “I hope our outcome can help put to rest the persistent assumption that women are poor risks for surgical training because they are likely to drop out, especially if they have children.”

A general surgery residency is considered one of the most rigorous, with 80-hour work weeks, a steep learning curve and unpredictable workloads for five to seven years beyond medical school. Attrition in these programs tends to be high — between 14 and 26 percent nationwide.

While other studies have considered the link between gender and the risk of residency attrition, with inconclusive results, the current study — published online in JAMA Surgery — is believed to be the first to examine whether child rearing during training also increases that risk.

The researchers included 85 residents — 49 men and 36 women — who participated in the UC Davis general surgery residency program between 1999 and 2009. During that time, nearly equal numbers of male and female residents left the program: seven women and nine men. In addition, nine women reported a total of 10 pregnancies and 16 men reported raising 21 children. Attrition for these groups was very low: One man and one woman with children left the residency program.

Beyond gender and child rearing, the team considered marital status, age, caseload, board passage rates and fellowship training. Being married was the only factor linked with a lower risk of attrition. In addition, female residents with children were more likely to pursue specialty training through fellowships than women who did not have children.

The study authors said that a larger, multi-center study is needed to fully address the high attrition rates among physicians training to be general surgeons. They hope, however, that their results broaden the conversation about solutions.

“Attracting and retaining physicians who have the potential to be great surgeons is a challenge for residency programs, but we need to look beyond lifestyle and gender in solving it,” said Diana Farmer, senior author of the study and chair of the UC Davis Department of Surgery. “If we better prepare trainees for the demands of residency and ensure they have good work-life balance support, I know we'll enable dedicated and talented physicians to enjoy very fulfilling surgical careers.”

Other study authors were Joseph Galante, Benjamin Keller and Juanita Braxton of UC Davis. The team received no external funding for this research.

The study, titled “Pregnancy-Related Attrition in General Surgery,” will appear in the September 17 issue of the journal. Reporters can request a copy by e-mailing mediarelations@jamanetwork.org.

UC Davis Health System improves lives by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education and creating dynamic, productive community partnerships. It encompasses one of the country's best medical schools, a 619-bed acute-care teaching hospital, a 1,000-member physician practice group and the Betty Irene Moore School of Nursing. Together, they make UC Davis a hub of innovation that is transforming health for all. For information, visit www.healthsystem.ucdavis.edu.